BACKGROUND: Statins were initially used to improve cardiovascular outcomes in people with established coronary artery disease, but recently their use has become more common in people at low cardiovascular risk. We did a systematic review of randomized trials to assess the efficacy and harms of statins in these individuals. METHODS: We searched MEDLINE and EMBASE (to Jan. 28, 2011), registries of health technology assessments and clinical trials, and reference lists of relevant reviews. We included trials that randomly assigned participants at low cardiovascular risk to receive a statin versus a placebo or no statin. We defined low risk as an observed 10-year risk of less than 20% for cardiovascular-related death or nonfatal myocardial infarction, but we explored other definitions in sensitivity analyses. RESULTS: We identified 29 eligible trials involving a total of 80,711 participants. All-cause mortality was significantly lower among patients receiving a statin than among controls (relative risk [RR] 0.90, 95% confidence interval [CI] 0.84-0.97) for trials with a 10-year risk of cardiovascular disease < 20% [primary analysis] and 0.83, 95% CI 0.73-0.94, for trials with 10-year risk < 10% [sensitivity analysis]). Patients in the statin group were also significantly less likely than controls to have nonfatal myocardial infarction (RR 0.64, 95% CI 0.49-0.84) and nonfatal stroke (RR 0.81, 95% CI 0.68-0.96). Neither metaregression nor stratified analyses suggested statistically significant differences in efficacy between high-and low-potency statins, or larger reductions in cholesterol. INTERPRETATION: Statins were found to be efficacious in preventing death and cardiovascular morbidity in people at low cardiovascular risk. Reductions in relative risk were similar to those seen in patients with a history of coronary artery disease.
BACKGROUND: Statins were initially used to improve cardiovascular outcomes in people with established coronary artery disease, but recently their use has become more common in people at low cardiovascular risk. We did a systematic review of randomized trials to assess the efficacy and harms of statins in these individuals. METHODS: We searched MEDLINE and EMBASE (to Jan. 28, 2011), registries of health technology assessments and clinical trials, and reference lists of relevant reviews. We included trials that randomly assigned participants at low cardiovascular risk to receive a statin versus a placebo or no statin. We defined low risk as an observed 10-year risk of less than 20% for cardiovascular-related death or nonfatal myocardial infarction, but we explored other definitions in sensitivity analyses. RESULTS: We identified 29 eligible trials involving a total of 80,711 participants. All-cause mortality was significantly lower among patients receiving a statin than among controls (relative risk [RR] 0.90, 95% confidence interval [CI] 0.84-0.97) for trials with a 10-year risk of cardiovascular disease < 20% [primary analysis] and 0.83, 95% CI 0.73-0.94, for trials with 10-year risk < 10% [sensitivity analysis]). Patients in the statin group were also significantly less likely than controls to have nonfatal myocardial infarction (RR 0.64, 95% CI 0.49-0.84) and nonfatal stroke (RR 0.81, 95% CI 0.68-0.96). Neither metaregression nor stratified analyses suggested statistically significant differences in efficacy between high-and low-potency statins, or larger reductions in cholesterol. INTERPRETATION: Statins were found to be efficacious in preventing death and cardiovascular morbidity in people at low cardiovascular risk. Reductions in relative risk were similar to those seen in patients with a history of coronary artery disease.
Authors: Peter S Sever; Björn Dahlöf; Neil R Poulter; Hans Wedel; Gareth Beevers; Mark Caulfield; Rory Collins; Sverre E Kjeldsen; Arni Kristinsson; Gordon T McInnes; Jesper Mehlsen; Markku Nieminen; Eoin O'Brien; Jan Ostergren Journal: Lancet Date: 2003-04-05 Impact factor: 79.321
Authors: James Shepherd; Gerard J Blauw; Michael B Murphy; Edward L E M Bollen; Brendan M Buckley; Stuart M Cobbe; Ian Ford; Allan Gaw; Michael Hyland; J Wouter Jukema; Adriaan M Kamper; Peter W Macfarlane; A Edo Meinders; John Norrie; Chris J Packard; Ivan J Perry; David J Stott; Brian J Sweeney; Cillian Twomey; Rudi G J Westendorp Journal: Lancet Date: 2002-11-23 Impact factor: 79.321
Authors: Eric Bruckert; Michel Lièvre; Philippe Giral; Gaetano Crepaldi; Luis Masana; Matthias Vrolix; Eran Leitersdorf; Sylvie Dejager Journal: Am J Geriatr Cardiol Date: 2003 Jul-Aug
Authors: Lars Rejnmark; Niels Henrik Buus; Peter Vestergaard; Lene Heickendorff; Frederik Andreasen; Mogens Lytken Larsen; Leif Mosekilde Journal: J Bone Miner Res Date: 2004-02-16 Impact factor: 6.741
Authors: Maria I Van Rompay; Keith R Solomon; J Curtis Nickel; Gayatri Ranganathan; Philip W Kantoff; John B McKinlay Journal: Eur J Cancer Date: 2019-03-06 Impact factor: 9.162
Authors: J Bradley Layton; M Alan Brookhart; Michele Jonsson Funk; Ross J Simpson; Virginia Pate; Til Stürmer; Abhijit V Kshirsagar Journal: Pharmacoepidemiol Drug Saf Date: 2013-08-20 Impact factor: 2.890